This article was collaboratively written by A. Mark Fendrick, MD, director of the V-BID Center, and several V-BID Center staff. The following infographic was created by V-BID Center staff.

The use of low-value care and the associated cost is a significant concern in the US healthcare system—the National Academy of Medicine (formerly the Institute of Medicine) indicated an estimated $765 billion of wasted healthcare expenditures in 2013. However, solutions to measure, identify, and eliminate low-value care are challenging and complex. To date, most efforts aimed at reducing low-value care, such as the Choosing Wisely Initiative, have been limited to areas where there is a high degree of consensus that the care rendered is low value.

Value-based insurance design (VBID) is an innovative approach that has the potential to simultaneously improve health and contain costs, while maintaining the sanctity of the patient-provider relationship and avoiding major structural changes to the employer-based private insurance system.1 VBID programs that align out-of-pocket spending with the value of medical services could both improve quality and control spending by increasing the use of highly effective interventions while decreasing the use of ineffective services. This "carrot and stick" approach has been discussed on a conceptual level2 and has received national media attention.3 However, most VBID programs have not explicitly designated low-value services, nor have they limited their use.